Prescribing Safety Assessment (PSA) Practice Exam

Which antihypertensive is associated with causing a dry cough?

1. Beta Blockers

2. ACE Inhibitors

3. Diuretics

4. Calcium Channel Blockers

The correct answer is: ACE Inhibitors

The association of a dry cough with the use of ACE inhibitors is well documented and is one of the most recognized side effects of this class of antihypertensive medications. ACE inhibitors work by blocking the angiotensin-converting enzyme, which leads to decreased production of angiotensin II—a potent vasoconstrictor that increases blood pressure. In the process, they also prevent the breakdown of bradykinin, a peptide that can promote vasodilation but is also linked to the side effect of cough. Elevated levels of bradykinin can irritate sensory nerves in the respiratory tract, leading to the characteristic dry cough that many patients experience while on these medications. The other classes of antihypertensives listed do not typically lead to a dry cough as a side effect. Beta blockers primarily affect heart rate and cardiac output and are not known for causing cough. Diuretics are mainly involved in promoting urine production and fluid balance, and they do not have cough as a common side effect. Calcium channel blockers work by dilating blood vessels and are not associated with cough either. Hence, the link between dry cough and ACE inhibitors is significant and a key consideration when prescribing these medications.